Quality Payment Program Overview

Quality Payment Program (QPP) Eligibility

Beginning in Performance Year 2019, CMS increased the low volume threshold for QPP participation. Individuals and groups that do not meet the low volume threshold are not required to report MIPS or participate in an APM. Physicians and other clinicians fall under the low-volume threshold and receive an exemption from MIPS if they:

  • Bill $90,000 or less in Medicare Part B allowed charges for covered professional services payable under the Physician Fee Schedule; or
  • Provider covered professional services for 200 or fewer Part B-enrolled individuals; or
  • Provide 200 or fewer covered professional services to Part B-enrolled individuals.

Individuals and groups that exceed at least one but not all of the thresholds may opt-in to report MIPS. Once an individual or group decides to submit data to CMS via the opt-in option, they will be scored and payment adjustments based upon their performance will apply.

For individuals and groups wishing to participate in an Advanced APM, these requirements must be met:
  • Use certified electronic health record technology (CEHRT)
  • Provide payment for covered professional services based on quality measures comparable to those used in the quality performance category of MIPS
  • Either be a Medical Home Model expanded under CMS Innovation Center authority; or requires participating APM entities to bear more than a nominal amount of financial risk for monetary losses.

Individuals and groups can check their participation status, including if they participate in an APM, on the Quality Payment Program (QPP) website.